Central Vestibular Syndromes

Although peripheral vestibular disorders account for the most cases of dizziness or vertigo, approximately 11-15% of patients have central vestibulopathy. This remains a diagnostic challenge for neurotologists, as it can present with acute vestibular syndrome (AVS) in isolation without other obvious neurologic deficits. Despite advances in modern neuroimaging, false-negative results still occur in up to 20% of cases, further complicating the differential diagnosis. Therefore, recognition of the characteristic neurotologic signs associated with each central neural structure is important for the early detection and proper management of central AVS. In this review, we discuss the typical neurotologic findings related to the underlying neural substrates of the brainstem and cerebellum.